SP Plastic Surgery, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

57866 Issued in MN

Legal business name

SP PLASTIC SURGERY, LLC

Practice address

15450 Highway 7
Ste 225
Minnetonka, MN 55345-3522

Phone

(763) 999-4170

Fax

(763) 951-0941

NPI assigned

Jun 25, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie Lee Peng, MDNPI 1841455383

Title

President

Phone

(763) 999-4170

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephanie Lee Peng, M.D.

  • Plastic Surgery Physician
  • Minnetonka, MN
  • NPI 1841455383
  Medicare reassignment Authorized official
• Jennifer Marie Hook Varella Barca, PA-C

  • Physician Assistant
  • Saint Paul, MN
  • NPI 1780930339
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1114332301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15450 HIGHWAY 7",
            "address_2": "STE 225",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553453522",
            "telephone_number": "763-999-4170",
            "fax_number": "763-951-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 HIGHWAY 7",
            "address_2": "STE 225",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553453522",
            "telephone_number": "763-999-4170",
            "fax_number": "763-951-0941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SP PLASTIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-25",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "PENG",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-999-4170",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MN",
            "license": "57866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Callahan Soto, M.D.
• Soulspire, LLC
• South Lake Clinic, P.a.
• South Lake Clinic, PA
• Greta Sowles, PA-C
• Debra Spangler
• Reece Spears
• Spectrum Counseling, LLC
• Kathryn Kim Spillane, CRNP
• Alan Spiro

• Plastic Surgery Physician in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Plastic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.